Результаты хирургического лечения артериальных аневризм головного мозга на примере 100 пациентов

Objective evaluate the patterns of results in surgical treatment of patients with brain arterial aneurysms (AA), depending on the patient’s condition on admission, the timing of surgery and localization of aneurysms. Materials and methods. A retrospective analysis of 100 consecutive patients with AA that were treated at the Uzhhorod Regional Clinical Center of Neurosurgery and Neurology from 2007 to 2012. Distribution of patients by sex and age was as follows: male prevalence 51 %, age of patients from 10 to 69 years old, mean age 39.5 years. There were 111 aneurysms in 100 patients, nine of them harbouring multiple AA: two 3 and seven 2. At admission the clinical status of patients was assessed according Hunt-Hess scale. All patients underwent computed tomography (CT), CT-angiography and/or magnetic resonance angiography and digital subtraction cerebral angiography to clarify the anatomy of AA and reserves of cerebral hemodynamics. The results of treatment were evaluated on a Glasgow Outcome Scale (GOS). Results. Good and satisfactory results (GOS IV, GOS V) 83 %. The best results of surgical treatment were observed in «cold» period (over 14 days) with the GOS IV and GOS V outcome in 87 % and in patients with 0-II Hunt-Hess scale on admission 74 %. Overall postoperative mortality 10 % (microsurgery 9.7 %, endovascular surgery 12.5 %), in case of anterior circulation aneurysms 9 and 20 %, in case of posterior circulation aneurysms 25 and 0 %.conclusions. Good outcomes are directly proportional to the timing of the surgery («cold» period) and to the patient condition at admission according Hunt-Hess scale. The most unfavorable factors are poor clinical condition of the patient and rerupture of the aneurysm.